We all see the news that medical bills are absolutely nuts and out of control. At Resolve we see this up close and personal every single day. Our Advocates dig through mountains of medical bills identifying crazy errors, appealing insurance claim denials, and pushing back against bad acting hospitals.
Here are 5 real life examples of crazy out of control medical bills that we’ve seen and solved.
Example #1: Hospital sending a patient to collections for $30k even after getting paid by insurance ($27k savings, 90% off)
We had a patient who went to the hospital in 2016 and had insurance at the time. Naturally, he assumed he was covered and when the hospital never sent him a bill he went on with his life.
Three years later he went to buy a house and was shocked to discover that he had a mark on his credit report for nearly $30,000 in unpaid medical bills. The collections agency, hospital, and insurance company were all no help to him – so he called resolve.
Our advocates got to work reviewing all of his bills and notices and, working with the hospital, were able to discover that his health insurance had actually paid the majority of the bill and that the hospital was mistaken in sending him to collections.
We then coordinated with the collections agency to pull the bills out of collections and reduce the amount owed to $3k, for a savings of 90%.
Example #2: $89k bill for a patient out of town on vacation ($51k savings, 58% off)
One of our patients was traveling on vacation and ended up in the hospital with a bill of over $100k.
While he had health insurance, it was a non-marketplace plan that only paid him $2k of the over $100k charge while providing a $20k “pre-negotiated discount” – leaving him stuck with a bill of just under $90k (side note – check out our blog post on Fake Health Insurance to make sure that you’re properly covered in the event of an emergency like this).
The hospital he attended is notorious for pursuing aggressive legal action against non-paying patients, to the point that there are laws on the county books detailing exactly when and under what circumstances said hospital is legally allowed to place a lien on a patient’s personal property. Unfortunately the laws legally permitted the hospital to place liens and pursue legal action in this instance.
Our Fair Price Analysis of the bill determined that the hospital was still overcharging by a factor of 2x. We then went to work arguing his case and working our way up the bureaucratic chain in the hospital to find the right decision maker.
Despite the threat of legal action by the hospital, we were able to save the patient over $50k on the bill – dropping it down below $40k and saving nearly 60%.
Example #3: $36k ER bill for a pensioner visiting the US from Canada (nearly $26k savings, 71% off)
A retired teacher from Canada came to the US for an escape from the cold winter. Aware that the US health system is very different from the Canadian system, she purchased travel insurance ahead of time.
While here, she ended up in the Emergency Room during her time in the US. Despite a terrible experience which included extraordinarily long wait times and being lied to, she assumed her insurance would cover the bill and all would be well.
Unfortunately, her insurance denied coverage for a ‘pre-existing condition’ (which is, unfortunately, still legal in certain instances, and very difficult to dispute). On top of that, when she called the hospital to request assistance, she was made to feel like a deadbeat for not being able to pay. Unsure of how to deal with such a large bill she turned to us.
We ran a Fair Price Analysis of the bill and determined that on average insurance would have paid the hospital approximately $11k for the services that they were now charging our out of town retiree $36k (side note – that’s 3.3 times the rate just because the hospital was charging an individual rather than an insurance company).
Armed with this information we took her case to directly to hospital management and were able to negotiate the bill down to just over $10k (or less than insurance would pay) – a savings of over 70%.
Example 4: $35k ER bill patient had already negotiated ($25k in savings, 72% discount)
A trip to the ER and emergency surgery generated a $50k medical bill for one of our patients. The patient, realizing himself that this was a massive overcharge, was able to go to the hospital and negotiate a 30% discount (or $15,000 in savings) – bringing the bill down to just over $35k.
Despite working extremely long hours, this was still significantly more than the patient could afford to pay so he turned to us to see what else could be done.
Our Fair Price Analysis determined that this newly offered price was still over twice the average amount that an insurance company would pay for the same services (for those keeping track, that means the hospital is charging uninsured patients over 4 times the amount that insurance companies pay).
We were able to work with the hospital to come an agreement for the patient to pay just under $10k, which is a significant discount off of what insurance normally pays.
Example #5: Insurance refusing to cover $40k in medically necessary care that could only be found out of network ($40k savings, 100% reduction for the patient)
A patient in the midwest with neuro-spinal complications had to go to the one specialist within a 1,000 mile radius to receive life-saving treatment. She had high quality health insurance and assumed that they would cover this life-saving treatment, as there was nowhere else for her to turn.
Two months later, while still working through ongoing treatment, her insurance company denied coverage – claiming that it was out of network and not medically necessary. The hospital that she was going to for treatment subsequently billed her $40k for past care and told her that she would need to pay for any upcoming care.
Not having the money to pay, needing treatment just to stay alive, and feeling completely backed into a corner, she turned to us to sort things out.
We took her case directly to the insurance company – successfully proving that a) the care she received was medically necessary, and b) there was nowhere in network for her to go to receive this needed care. The insurance company reversed their decision and covered the care at 100%, saving the patient over $40k.
Conclusion
As you can see from these cases – not only can the medical bill from the hospital be completely wrong, but its common for prices to be incredibly inflated – even after initial negotiations with the hospital.
It’s important to read through things extremely carefully and double check all charges with both your insurance company and the hospital.
If you’re still confused or worried about being overcharged, we’re happy to help. Give us a call at 877-245-4244 for a free consultation to see what can be done about your medical bills.
Braden founded Resolve after experiencing first hand how unfair the system is for patients. Prior to Resolve, he built and ran Operations for a renewable energy company and then built and ran Product, Growth, and Operations for a VC-funded edtech company. He received his MBA from Dartmouth’s Tuck School of Business and BA in Philosophy from the College of William and Mary. When not trying to lower healthcare costs he can be found outdoors mountain biking, skiing, or hiking with his dog.